Individual
TANIQUA BROCKINGTON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
5936 CHANCELLOR ST, PHILADELPHIA, PA 19139-3826
(267) 320-0045
Mailing address
5936 CHANCELLOR ST, PHILADELPHIA, PA 19139-3826
(267) 320-0045
Taxonomy
Speciality
Code
Description
License number
State
376K00000X
Nurse's Aide
Primary
—
—
Other
Enumeration date
11/16/2022
Last updated
11/16/2022
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